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I DEC. 8. 2003 2: 16PM CONDOR EARTH TECH , I , ,NO. 1697 EHIP, INUMBER <br /> DATE RECEIVED SAN JOAQM COUNTY <br /> DEPARTmZNT <br /> ENVIRONMEnAL IUALTH <br /> IL <br /> 304 E Weber Ave 3'.Floor Stockton. CA 95205 <br /> 1)E n 468-3420 Fax: (209)464-0138 Web: www.cO.san_jOa4ujn.caus/ehd <br /> pUBLIc RECORDS RIELEASE APPLICATION <br /> (2:�L)'ba r< <br /> APPLICANT: L_ BUSINFESSIAGENCY:_ <br /> ct,F_ SrF--. _T_ 'S 0C KTo <br /> ADDRESS: <br /> PHONE S)Z;(-2'—FACSIMILE.. <br /> - <br /> TENTATIVE -APPOINTMENT DATE: Time. <br /> (plwAseatiowlabusiness days from date 0tapplication submiltal) <br /> nnc <br /> CHECK BOX TO F-XPgDrrE REQUF-S - 93.00 FEE-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> TA <br /> SIGNATURE OF APPLICANT C DATE C) <br /> Department Use Only <br /> UNIT <br /> FU F_ADDRESS <br /> st unit I <br /> It 2. Stft 2 <br /> 3. 2-71 ' 1 �--7 <br /> x AT Vy <br /> Ave R�e :r= �h"l <br /> �e, 5. st,� 1 -,�14 Uls-ow iLe <br /> n R nnn n fff_ <br /> Nli C1 �Pdj444Unit, <br /> 7. ft,1A C29-7:2 <br /> Ck Ell.. 8 <br /> 0 Un i <br /> 1d. Sueat <br /> Wad4 <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LDP) 0 HOU15INGARATIEMENT s o u o wAs TE FACILITY <br /> uT Y <br /> OTHER CLEANUP SITE(NON-LOP) dFOOD FACILITYSOLID WASTE VEHICLE <br /> UNDERGROUND TANK(MONITORINGIREMOVAL) M DOG KENNEL EJ DAIRY <br /> [3 CHICKEN RANCH 0 PKG TREATMENT PLANY <br /> HAZARDOUS WASTE GENERATOR KryARDI M TOILETS <br /> E3 MOTELIHOTEL, M PUMPER TRUIC Q <br /> TIERM PERMITTED FACILITY USE APPLICATION 5 <br /> 0 TATTOO/BODY PIERCING CI POOLISPA 0 LAND U Alb <br /> 0 M5DICALWASTr;FACILITY [3 OTHER(PLEASE SPECI <br /> j <br /> 1. List up to ton addresses in the spaCLabove. Select the type(S)of files from the list aboYe checking <br /> the appropriate box(es). At least one file type MUST be selected. Fax to 1209 4§1&138 o mail to the <br /> address Indicated above. <br /> 2- EHD will notify the applicant if any EHD files exist An appointment for review will be cofirmed <br /> approximately five business days but no later than ten(10) days after receipt Of apPli on. The files <br /> will be held for a maximum of five business days for review. Appointments should •the list <br /> accordingly. la review. Anew <br /> 3. A file that is actively being worked on by EHD staff may not be immediately available for <br /> application may be submitted when the file Is available. <br /> 4. Any file not returned in the same condition as released will be reorganized by EHD staff at the expense <br /> of the applicant. Future file reviews by the same applicant may require a$93.00 deposit prior to-review. <br /> 5. *TENTATIVE appointment dates must be confirmed With EHD staff. <br /> 6. Applications received after 3.'00 pm Will be processed the next business day. <br /> CONFIRMF-D APPOINTMENT DATE TIME <br /> lNfflALS* ----------- <br /> DATE CONFIRMED 'PHONE FAX <br /> REVIEWED YES NO REVIEW DATE' <br /> oto*n_m <br />